Why WHO opted for a policy of isolation

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Andrew Feinberg

White House Correspondent

The scale of the threat posed by Sars is still unknown. For the victims and their families, whose numbers continue to mount, it is a personal tragedy. For the economies of the Far East and, now, Toronto, it is already a catastrophe. For the World Health Organisation (WHO), it is the biggest challenge it has faced.

Since late February, when the WHO was first alerted to the emergence of a strange new disease in Hong Kong that appeared to have come out of southern China, experts at the organisation's Geneva headquarters have been working round the clock to contain the organism that was causing it.

By 12 March, when the WHO issued its first global alert, three things had become clear. This was a lethal disease that was spreading exceptionally fast and it was targeting doctors and nurses. It was nastier than flu, spread faster and wider than the Ebola virus and, by cutting down health workers, threatened to disable hospitals.

Over the next three days, as reports of suspected cases poured in from nine countries, Gro Harlem Brundtland, the WHO director general, declared the infection a "worldwide health threat". This was a new disease but, just as important, it had found a new mode of spread: modern air travel.

The early warning had the desired effect. Travellers and the countries to which they were travelling were alerted, suspect cases were quickly identified and isolated.

But the warning came too late for Hong Kong and Toronto, where the disease already had a three-week start. The failure of the Chinese authorities to declare the outbreak in Guangdong province where, it emerged, it had been brewing for six months, left Hong Kong unprepared when the virus arrived at the Metropole Hotel, carried by a professor who had treated Sars patients in China.

From there it was transmitted to Toronto, where again it had three weeks to get a hold before the disease was recognised. In extending its travel warning to include Toronto on Wednesday, the WHO cited the "high magnitude of disease", a "great risk of transmission locally outside the usual health workers" and "exporting of cases".

While the WHO's network of 13 laboratories in 11 countries worked to identify the virus, public health experts conferred on just how draconian the measures to contain the virus would have to be. The travel restrictions have already wreaked havoc. But the damage they have caused has to be balanced against the long-term threat posed by the first global epidemic of this century. If Sars can be contained now, the world may be spared much worse suffering later.